Epidemiology and burden of progressive familial intrahepatic cholestasis: a systematic review
Tracey Jones-Hughes1, Jo Campbell2, Louise Crathorne2
1, Roboleo & Co, Leeds, UK. tracey@roboleo.com.
Insights
Progressive familial intrahepatic cholestasis (PFIC) is a rare liver disease causing significant distress. Data on PFIC epidemiology and outcomes are limited and highly variable, hindering a clear understanding of the condition.
Area of Science:
- Hepatology
- Genetics
- Pediatric Liver Disease
Background:
- Progressive familial intrahepatic cholestasis (PFIC) is a group of rare, inherited liver disorders.
- Characterized by early-onset cholestasis, pruritus, malabsorption, and progressive liver failure.
- PFIC causes significant distress, with severe pruritus impacting daily life and leading to cutaneous mutilation.
Purpose of the Study:
- To systematically review current knowledge on the epidemiology, burden of disease, and health-related quality of life in PFIC.
- To summarize available data on prevalence, incidence, natural history, and outcomes of PFIC.
- To identify gaps in understanding due to data limitations and heterogeneity.
Main Methods:
- Systematic review of publications on PFIC prevalence, incidence, natural history, economic burden, and quality of life.
- Searches conducted in MEDLINE and Embase databases.
- Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Main Results:
- Included three systematic reviews and twenty-two studies with 2603 PFIC patients.
- Prevalence varied, reported as 9.0–12.0% of children with cholestasis, acute liver failure, or splenomegaly.
- Data on native liver survival (e.g., PFIC2 patients >15 years with specific bile acid levels post-surgery) and outcomes like transplant rates were highly variable and limited.
Conclusions:
- This systematic review highlights the heterogeneity and data limitations in understanding PFIC.
- Epidemiological data and patient outcomes vary significantly by PFIC subtype and presentation.
- Extensive heterogeneity and lack of data impede a comprehensive understanding of PFIC, particularly variations within and across subtypes.
Background:
Progressive familial intrahepatic cholestasis is a rare, heterogeneous group of liver disorders of autosomal recessive inheritance, characterised by an early onset of cholestasis with pruritus and malabsorption, which rapidly progresses, eventually culminating in liver failure. For children and their parents, PFIC is an extremely distressing disease. Significant pruritus can lead to severe cutaneous mutilation and may affect many activities of daily living through loss of sleep, irritability, poor attention, and impaired school performance.
Methods:
Databases including MEDLINE and Embase were searched for publications on PFIC prevalence, incidence or natural history, and the economic burden or health-related quality of life of patients with PFIC. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.
Results:
Three systematic reviews and twenty-two studies were eligible for inclusion for the epidemiology of PFIC including a total of 2603 patients. Study periods ranged from 3 to 33 years. Local population prevalence of PFIC was reported in three studies, ranging from 9.0 to 12.0% of children admitted with cholestasis, acute liver failure, or splenomegaly. The most detailed data come from the NAPPED study where native liver survival of >15 years is predicted in PFIC2 patients with a serum bile acid concentration below 102 µmol/L following bile diversion surgery. Burden of disease was mainly reported through health-related quality of life (HRQL), rates of surgery and survival. Rates of biliary diversion and liver transplant varied widely depending on study period, sample size and PFIC type, with many patients have multiple surgeries and progressing to liver transplant. This renders data unsuitable for comparison.
Conclusion:
Using robust and transparent methods, this systematic review summarises our current knowledge of PFIC. The epidemiological overview is highly mixed and dependent on presentation and PFIC subtype. Only two studies reported HRQL and mortality results were variable across different subtypes. Lack of data and extensive heterogeneity severely limit understanding across this disease area, particularly variation around and within subtypes.
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